Individual
CHARLES BERNARD HOLMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10547 S EWING AVE, CHICAGO, IL 60617
(773) 221-1690
(773) 221-1675
Mailing address
10547 S EWING AVE, CHICAGO, IL 60617
(773) 221-1690
(773) 221-1675
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036082785
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01627279
BCBS
IL
01
—
050089383
RAILROAD MEDICARE
IL
01
—
349127900
DEPT OF LABOR
IL
Enumeration date
07/31/2006
Last updated
04/30/2015
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